Do You Know Your Payment Options for Senior Care in PA?

Making the decision to place your loved one into long-term care in Pennsylvania comes with a lot of questions: Which elderly care community is the right one? Will they be properly cared for? What will their quality of life be like? And most pressing of all — who’s paying for senior care, and how? Nursing homes aren’t inexpensive. Luckily, there are options and programs like Medicaid to help ease the financial burden of elderly assistance in the Scranton area.

According to the Genworth Financial Cost of Care 2017 Survey, the annual median cost of long-term care services increased an average of 4.5 percent from 2016 to 2017, the second-highest year-over-year increase for nursing homes and home care since the study began in 2004 and nearly three times the 1.7 percent U.S. rate of inflation. With costs on the rise, it’s more important than ever to understand the payment options available to you and your loved ones.

Resources from organizations like the Pennsylvania Department of Aging can help you navigate these waters so you can understand the costs associated with assisted living/personal care, home care, and adult day care throughout the state. Other tools like a Cost of Care Calculator provide invaluable context when comparing your options. Still, it helps to begin this process with a general understanding of the long-term care options available to you and the estimated costs you can expect to pay for each.

To help you get started, we’ve outlined some of the elderly assistance programs available in Pennsylvania:

Adult Day Care:
For individuals who’d like to stay in their home, nonresidential adult day care is the most affordable option; however, some additional assistance could be necessary. In Pennsylvania, the average cost of this service is $62 per day.

Assisted Living/Personal Care:
Across the state, the average monthly cost of assisted living is $3,650. Fortunately, for those in the Scranton area, costs range from approximately $2,550-$3,056 per month, significantly lower than the state average. Of course, an increased level of care means an increase in cost. Assisted living residents with Alzheimer’s should expect to pay an extra $1,150 per month.

Home Care:
Statewide, residents can expect to pay an average hourly rate of $22 for home care. Home health care, provided by health care professionals, is also an option for elderly care and costs approximately $1.50 per hour more than home care.

Nursing Home Care:
The median daily rate for nursing home care in a semiprivate room in Pennsylvania was $289 in 2015. Nationally, the median daily rate was $220. For private rooms, the median cost increased to $310, compared to $250 in the rest of the United States. In the Scranton area, specifically, the cost for a semiprivate room ranged in 2017 from $200 to $345 per day, with private rooms costing an additional $10 to $15.

Now that you have a general understanding of the types of care available, your next question is likely to be, “Who’s paying for senior care?” Pennsylvania’s Medicaid program will pay for nursing homes or home care if income and assets are limited and a doctor certifies that care is needed. In 2017, approximately 60 percent of nursing home residents in Pennsylvania used Medicaid to pay for nursing home care. While there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities and home health care services, you or your loved one can become eligible for Medicaid in Pennsylvania in a variety of ways.

If a person receives social security income (SSI), they’re already eligible for Medicaid. Those who don’t receive SSI but are 65 or older, disabled, or blind, can qualify for Medicaid if they meet certain income and asset limits.

Pennsylvania’s Medicaid benefit for elderly, disabled and blind individuals is called Non Money Payment (NMP) Medicaid. Eligibility for NMP Medicaid can be met if a person’s income is equal to or less than 300 percent of the monthly SSI benefit amount (also known as the federal benefit rate, or FBR). In 2018, the FBR is $750, and the individual NMP income limit is $2,250/month.

If the income level is above the 300 percent FBR limit, a person can still qualify for Medicaid by putting additional monthly income into a specified bank account set up as a special needs, or qualified income, trust.

Pennsylvania also offers a Medically Needy Program that allows a resident to use medical bills, including nursing facility bills, that incur each month to “spend down” income and qualify for Medicaid Needy Only (MNO) Medicaid. The MNO income limit is $425/month, meaning that medical expenses incurred each month would leave a resident with no more than $425. Upon application, a county assistance officer estimates the income and expenses for six months to see whether the adjusted income is less than $2,550 ($425/month for six months). The actual or anticipated cost of a long-term care facility for a six-month period is an allowable expense to qualify for MNO Medicaid.